Procedure For Relief Research Articles

After Losing the Tax Lawsuit, Can I Resort to Tax Refund or State Compensation Procedures for Relief ?

After Losing the Tax Lawsuit, Can I Resort to Tax Refund or State Compensation Procedures for Relief ?

Sonographic imaging of the genicular nerves of the knee

Introduction: The genicular nerves are sensory nerves around the knee. With the improvements in ultrasound imaging resolution, these nerves can be identified sonographically. Topic description: Due to their small size, genicular nerves are often underappreciated and overlooked during routine sonographic imaging. Chronic pain associated with knee osteoarthritis, or postsurgical knee pain can be relieved by ultrasound-guided radiofrequency ablations or nerve blockades targeting the genicular nerves. Discussion: To sonographically image these nerves, or guide nerve blocks or ablations, knowledge of the sonographic anatomy, technique and normal appearances of the genicular nerves and their surrounding structures is required and is unpacked in this pictorial essay. Conclusion: Enhanced knowledge of the anatomy and a systematic approach to sonographically image and assess the genicular nerves of the knee can enhance the diagnosis of pathology, nerve injury or entrapment, and sonographic guidance of interventional procedures for pain relief.

The alterations in nerve growth factor concentration in plasma and synovial fluid before and after total knee arthroplasty

Total knee arthroplasty (TKA) is an effective procedure for pain relief; however, the emergence of postsurgical pain remains a concern. In this study, we investigated the production of nerve growth factor (NGF) and mediators that affect NGF production and their function in the synovial fluid and plasma after TKA. This study included 19 patients (20 knees) who had rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and knee osteoarthritis (OA) who underwent TKA, categorized into OA and non-OA groups. The levels of NGF, inflammatory cytokines, and lipid mediators were analyzed before and after surgery. The intraoperative synovial fluid NGF concentration was more than seven times higher in the non-OA group than in the OA group. The intra-articular NGF levels increased significantly by more than threefold postoperatively in the OA group but not in the non-OA group. Moreover, the levels of inflammatory cytokines and lipid mediators were increased in the synovial fluid of both groups. The intra-articular cytokines or NGF concentrations positively correlated with postoperative pain. Targeted NGF control has the potential to alleviate postsurgical pain in TKA, especially in patients with OA, emphasizing the importance of understanding NGF dynamics under different knee conditions.

Incidence of barotrauma in the formation of cadets aviators in the Brazilian air force

Middle ear barotrauma is a pathology that can occur due to ineffective equalization between the external and internal pressures of the middle ear and can be caused by everyday conditions, which we sometimes do not notice before a flight. It is important to instruct the aviators to identify conditions that expose them to this pathology in order to make their instructions at the Air Force Academy (AFA This study aims to measure the level of consciousness of the cadets on the subject, the recurrence of conditions that lead to the emergence of barotraumas, and the preventive measures used. A questionnaire with seven questions about barotrauma knowledge was applied to a sample of 40 Cadet Aviators of the second Squadron in 2023. All these cadets were conducting the Air training course when they answered the questionnaire. All were questioned as to their knowledge of barotrauma, symptoms, procedures for relief and treatment. The results showed that although cadets have broad knowledge on the subject, and more than half of those questioned admit to performing instructional flights in non-ideal health conditions. This behavior, besides greatly increasing the risk of occurrence of a barotrauma, shows that a preventive culture is not being cultivated in the cadets. It is necessary to reaffirm the dangers of a barotrauma during the training of cadets who are going to begin flight instruction. Cadet awareness of pathologies involving air activity is important to everyone, as it is, a matter of flight safety.

Single-center experience of transitioning from video-assisted laparoscopic to robotic Heller myotomy with Dor fundoplication for esophageal motility disorders

BackgroundVideo-assisted laparoscopic Heller myotomy (LHM) has become the standard treatment option for achalasia. While robotic surgery offering some specific advantages such as better three-dimensional (3D) stereoscopic vision, hand-eye consistency, and flexibility and stability with the endowrist is expected to be shorter in learning curve than that of LHM for surgeons who are proficient in LHM. The aim of this study was to describe a single surgeon’s experience related to the transition from video-assisted laparoscopic to robotic Heller myotomy with Dor fundoplication.MethodsWe conducted a retrospective observational study based on the recorded data of the first 66 Heller myotomy performed with laparoscopic Heller myotomy with Dor fundoplication (LHMD, 26 cases) and with the robotic Heller myotomy with Dor fundoplication (RHMD, 40 cases) by the same surgeon in Department of Thoracic Surgery of The First Affiliated Hospital of Nanchang University in China. The operation time and intraoperative blood loss were analyzed using the cumulative sum (CUSUM) method. Corresponding statistical tests were used to compare outcomes of both serials of cases.ResultsThe median operation time was shorter in the RHMD group compared to the LHMD group (130 [IQR 123–141] minutes vs. 163 [IQR 153–169]) minutes, p < 0.001). In the RHMD group, one patient (2.5%) experienced mucosal perforation, whereas, in the LHMD group, the incidence of this complication was significantly higher at 19.2% (5 patients) (p = 0.031). Based on cumulative sum analyses, operation time decreased starting with case 20 in the LHMD group and with case 18 in the RHMD group. Intraoperative blood loss tended to decline starting with case 19 in the LHMD group and with case 16 in the RHMD group.ConclusionsBoth RHMD and LHMD are effective surgical procedures for symptom relief of achalasia patients. RHMD demonstrates superior outcomes in terms of operation time and mucosal perforation during surgery compared to LHMD. Proficiency with RHMD can be achieved after approximately 16–18 cases, while that of LHMD can be obtained after around 19–20 cases.

Immediate Analgesic Effect of Non-thermal CO2 Laser Therapy (NTCLT) on Oral Ulcers in a Kidney Transplant Patient with Leukopenia

Introduction: The significant and immediate analgesic effect of Non-thermal CO2 Laser Therapy (NTCLT) as an efficient, safe, and innovative photobiomodulation (PBM) approach has been demonstrated in some painful oral lesions, such as recurrent oral aphthous ulcers, oral lesions of pemphigus vulgaris, and oral mucositis due to chemotherapy of solid tumors. Case Presentation: We report a case of a kidney recipient patient hospitalized due to pancytopenia, fever, and painful oral ulcers. According to the clinical features of the oral lesions and after extensive workups, drug-induced leucopenia, and the resultant leucopenia-induced oral ulceration were the most acceptable diagnoses for the patient. She was referred to our laser department for pain reduction of her painful oral ulcers by NTCLT. The CO2 laser (power: 1 watt) was irradiated through a thick layer of a completely transparent gel with very high water content while scanning the surface of the lesion with rapid circular motion of the defocused handpiece. Results and Conclusions: The pain of the patient's oral ulcer was relieved immediately and dramatically after NTCLT without any visible thermal side effects. The procedure was completely painless, and anesthesia was not required. The results of this report suggest that NTCLT can be considered a promising procedure for significant and instant pain relief of leucopenia-induced oral ulceration in kidney recipient patients without any thermal complications.

The Value of Multiple Medication Trials Prior to Balloon Sinuplasty in the Management of Chronic Sinonasal Disease

Introduction In patients with chronic rhinosinusitis, conservative interventions with extended medical trials are often attempted prior to procedural treatment. Balloon sinuplasty (BSP) is an established procedure for symptomatic relief from chronic rhinosinusitis. However, data suggesting the suboptimal efficacy of prolonged medication management trials, prior to BSP, is lacking. Objectives The purpose of this study was to evaluate the efficacy of prolonged medication management trials, prior to BSP, for patients with chronic rhinosinusitis. Methods A retrospective review was performed for all adults with chronic rhinosinusitis who received extended medical management prior to their BSP at two outpatient clinics, from November 1, 2013, to June 31, 2018. The patients' Sino-Nasal Outcome Test (SNOT) scores were compared between baseline, post-medication trials, and post-BSP. Results The SNOT scores of a total of 64 patients were collected. Overall, patients showed a significant worsening of symptoms during the medication management trials from baseline ( p = 0.002126) but significant improvement of symptoms after undergoing BSP ( p < 0.0001). Conclusion The patient symptom burden worsened and prolonged during medication management trials. The BSP procedure alone showed significant improvement in the quality of life for chronic rhinosinusitis patients, when considering their SNOT scores. The worsening of patients' symptoms during medication management may invalidate the necessity of prolonged medication management trials.

Robotic-assisted simple prostatectomy: long-term, trifecta- and pentafecta-based analysis of functional outcomes

Background: Robotic-assisted simple prostatectomy (RASP) proved to be a sound and effective procedure for bladder outlet obstructive symptoms relief. Routinely, the transvesical (Freyer) or transcapsular (Millin) techniques are performed. A novel approach of near-infrared fluorescence imaging (NIFI)-guided urethra-sparing robot-assisted prostatectomy (Madigan) was recently introduced. Objectives: The aim of our study was to evaluate the long-term functional outcomes between the Millin, Freyer, and Madigan RASP. Design: This is a single-center, retrospective evaluation of a prospectively maintained Institutional Review Board–approved database. Methods: Data from patients who have undergone RASP in our center were prospectively collected. Demographics, prostate size, and preoperative flowmetry parameters were assessed. Questionnaires such as International Index of Erectile Function (IIEF), and International Consultation on Incontinence Questionnaire (ICIQ), International prostatic symptoms score (IPSS) with its quality of life (QoL) score, Male Sexual Health Questionnaire (MSHQ), Overactive bladder questionnaire (OABQ) were administered to every patient preoperatively and during follow-up. We tested composite outcomes (trifecta) defined as a combination of postoperative Q-max &gt;15 ml/s, IPSS score &lt; 8, and absence of complications. We also tested a pentafecta which keeps in account the persistence of antegrade ejaculation (MSHQ &gt; 0) and the erectile function maintenance (∆IEEF &lt; 6). Results: Median follow-up was 36 months. Millin, Madigan, and Freyer procedures were performed in 37 (51%), 18 (25%), and 17 (24%) cases, respectively. Trifecta was achieved in 43 (60%) patients. Preoperative ICIQ, postoperative IPSS, postoperative OABQ, and QoL were significantly different between groups (all p &lt; 0.02). Pentafecta was achieved by 14 (20%) patients. The pentafecta group showed a statistically significant advantage in terms of postoperative IPSS and MSHQ ( p &lt; 0.01). Conclusion: RASP provides an effective and durable relief of obstructive symptoms at long-term follow-up, regardless of the technique, achieving the trifecta in the majority of the patients. The Madigan technique is significantly related to the pentafecta achievement.

Treatment of Dentinal Hypersensitivity with Diode Laser of Two Different WavelengthsA Randomised Clinical Trial

Introduction: Dentinal Hypersensitivity (DH) is one of the most prevalent dental issues that is treated by both periodontists and endodontists. Hypersensitive dentin is a sensitive or painful response that is one of the most prevalent and poorly treated chronic dental disorders. Due to the difficulty in treating cervical DH, a great range of approaches and therapeutic procedures for pain relief in have developed. Treatments with desensitising drugs have been combined with laser treatment in recent decades. The most often utilised lasers in the treatment of DH are Diode Lasers (DL). DL act on DH provoking a melting effect with crystallisation of dentine inorganic component and the coagulation of fluids contained into the dentinal tubules. Aim: To compare the effectiveness of DL of two different wavelengths in managing DH. Materials and Methods: This split-mouth randomised clinical trial conducted in the Department of Periodontology at Vishnu Dental College, Bhimavaram, Andhra Pradesh, India. The duration of the study was, from October 2021 to December 2021. A total of 12 patients with DH were selected and assigned to two groups. All the patients were subjected to desensitisation using DL of two different wavelengths 475 nm Bluelase system and 810 nm. Denlase system and parameters were evaluated 15 minutes after treatment, 7 days, 15 days and 30 days after treatment. Data were entered in Microsoft Excel and analysed using Statitical Package for Social Sciences (SPSS) version 10.5 software. Results: The mean age of the study participants was 45±3 years. There was a significant difference (p-value &lt;0.001) in tooth sensitivity values measured at baseline, and at different time intervals in both groups. Among the two groups, Denlase group showed the greatest reduction in Visual Analogue Scale (VAS) scores from baseline to one month recall compared to Bluelase laser group. Highly significant difference was found when mean VAS scores were compared between baseline and all the other time points (p-value &lt;0.001). Conclusion: The present study concluded that, based on the results obtained, DL of 810 nm Denlase system was effective than DL of 475 nm Bluelase system in reducing the DH. Desensitisation treatment with laser irradiation has shown to be effective in the present study.

Comparison of subomohyoid plane block and interscalene nerve block for arthroscopic shoulder surgery

ABSTRACT Background Ultrasound guided interscalene nerve block (ISB) is a popular procedure for pain relief in shoulder surgery patients. The subomohyoid plane block is a new reliable and technically easy regional technique that can be properly used for pain management with fewer adverse effects. The aim of this study was to validate whether there is a difference in postoperative pain scores and morphine consumption between interscalene and subomohyoid plane blocks. Method Eighty patients scheduled for shoulder arthroscopy were enrolled in this controlled blinded study and randomized to interscalene or subomohyoid plane blocks using 15 ml 0.5% bupivacaine in each group and general anesthesia. The primary outcome was pain severity at rest using VAS. Secondary outcomes were first 24 h total morphine consumption, patient satisfaction and adverse effects. Results All patients completed the study through the primary outcome analysis. VAS scores at PACU 2 h were similar in both groups, and VAS scores at 4, 8, 12,18 and 24 h were statistically lower in the interscalene block group (ISB) than in the subomohyoid group (p < 0.001), with no clinical significance. Total morphine consumption was lower in ISB group than in the subomohyoid group (p < 0.001). Time to the first rescue analgesic request and patients’ satisfaction were similar in both groups. Ipsilateral phrenic nerve was blocked in 37.5% of patients in ISB group vs. 7.5% in the subomohyoid group (p < 0.001). Conclusion Subomohyoid plane block can be considered as an alternative to interscalene block for shoulder arthroscopy surgery.

An Overview About Acne Vulgaris

Background: Acne vulgaris (acne) is a long-term inflammatory skin disease. Typical features of acne that often appears in adolescents on the forehead include visible, clinically recognized blackheads or whiteheads (comedones) that develop into inflammatory red papules or pustules and possible scarring. Acne primarily affects skin with a relatively high number of sebaceous glands including face, neck, chest, and upper back. Acne and postinflammatory hyperpigmentation have a strong negative impact on mental health, including mood disorde,r, depression, and suicidal thoughts. Also acne may cause low self-esteem, decrease social interactions and quality-of-life scores in adolescents. Typical features of acne include increased secretion of sebum by the skin, microcomedones (a structure invisible to the naked eye), comedones, papules, nodules, pustules, and often results in scarring. It may result in psychological and social problems. Acne lesions are classified into non inflammatory and inflammatory. Non inflammatory acne lesions consist of open and closed comedones. Open comedones are clearly obvious in the skin and can be found in the face centrally. Closed comedones, by inspection in a good light room, are slightly hypopigmented ,tiny, usually less than 1mm in size, with no visible opening . Comedones are superficial and can remain with no progress or get inflammed and become deep. Inflammatory acne lesions include papules ( red, inflammed, raised lesions of size less than 5 mm), pustules ( scattered pus-filled papules) and nodules ( lesions, 5 mm or larger in size). these lesions affect deep structures in the skin so their inflammation can lead to formation of scars. Acne vulgaris is a chronic skin disease of the pilosebaceous unit that occurs as a result of the following four factors: increased sebum production (due to increased activity of androgens and IGF-1), excessive deposition of keratin in pilosebaceous follicles leading to comedo formation, colonization of the follicle by P. acnes bacteria, and the local release of pro-inflammatory chemicals in the skin through certain inflammatory mechanisms. Limited evidence supports comedo extraction, but it is an option for comedones that do not improve with standard treatment. Another procedure for immediate relief is the injection of a corticosteroid into an inflamed acne comedo. Electrocautery and electrofulguration are effective alternative treatments for comedones. Inflammatory and non-inflammatory lesions are common in acne vulgaris, which is a complex illness linked to the pilosebaceous follicle. Since inflammation can occur in both the early stages of acne vulgaris and the late stages of the disease, inflammation plays a critical role in the development of acne vulgaris lesions, both inflammatory and non-inflammatory. There are different updated modalities for acne vulgaris treatment.

Pulsed Radiofrequency for the Treatment of Trigeminal Neuralgia.

Trigeminal neuralgia is a sudden, unilateral, stabbing pain in the distribution of one or more branches of the fifth cranial nerve, with an overall prevalence ranging between 0.03 and 0.3%. While conservative treatments may offer temporary relief, many patients experience chronic headaches associated with their neuralgia. Invasive treatments are available for patients with intractable neuralgia; however, they may cause permanent tissue damage and often do not provide relief. This article examines pulsed radiofrequency (PRF) ablation (RFA) of the trigeminal nerve as a minimally invasive procedure that offers a promising alternative to invasive procedures for relief of trigeminal neuralgia while minimizing tissue damage. Efficacy of PRF and RFA in treating trigeminal neuralgia has been studied before, but literature lacks large size studies. The results of this retrospective study indicate that PRF can be used as a safe and effective treatment for patients suffering from trigeminal neuralgia that is refractory to conservative measures.

Extension of iliac vein stent into the profunda femoral vein for salvage

BackgroundThe extension of iliac vein stents into the common femoral vein is often required to correct stenoses found at or near the inguinal ligament. Very rarely, an extension of the iliac stent into the profunda femoris vein may be required because of severe disease at the femoral trijunction. Profunda extension of iliac vein stents is a rare but useful technique for salvage. Our experience with extensions of iliac vein stents into the profunda femoris vein is described. MethodsA search of our electronic medical records identified 20 limbs (0.75%) among a total of 2641 stented limbs (years 2006-2017) in whom the iliac vein stent was extended into the profunda femoris vein. Patients had been followed at 6 weeks, 3 months, 6 months, and yearly thereafter following the index procedure. Routine follow-up consisted of a detailed clinical evaluation, including the Venous Clinical Severity Score, visual analogue pain scale assessment, and edema grading by physical examination. Stent surveillance was performed at the follow-up visits. The iliac vein stent was declotted if needed and then extended into the profunda femoris vein at the same sitting. Antegrade access of the profunda femoris vein was preferred by direct puncture near the lesser trochanter or through a popliteal approach when a profunda-popliteal connection was present. An internal jugular access was used when an antegrade approach failed. ResultsStent extension into the profunda was a secondary procedure after the initial iliac-common femoral vein stent failed in 17 of 20 limbs (85%). In three limbs (15%), the profunda extension was carried out at the initial iliac vein stent procedure because there was severe stenosis at the femoral confluence. One or more reinterventions after profunda extension were required in 50% of the limbs to maintain secondary patency or functionality. Fifteen of 20 limbs (75%) with profunda extensions remained patent on long-term follow-up. The median duration of secondary patency of stents that remained patent and those that occluded, and overall were 23 months, 3 months, and 10 months, respectively. Thirty percent of stents remained patent at 5 years. ConclusionsThe extension of an iliac vein into the profunda femoris vein is a rarely required but useful procedure for stent salvage and symptom relief. Corrective reinterventions are often required but can result in long term patency extending to many years.

MP08-17 SPINAL ANESTHESIA FOR INFANT OUTPATIENT GENITAL SURGERY

You have accessJournal of UrologyCME1 May 2022MP08-17 SPINAL ANESTHESIA FOR INFANT OUTPATIENT GENITAL SURGERY Jack Elder, Andrew Chen, Jacquelin Peck, Christine Mai, Diana Liu, David August, and Chang A. Liu Jack ElderJack Elder More articles by this author , Andrew ChenAndrew Chen More articles by this author , Jacquelin PeckJacquelin Peck More articles by this author , Christine MaiChristine Mai More articles by this author , Diana LiuDiana Liu More articles by this author , David AugustDavid August More articles by this author , and Chang A. LiuChang A. Liu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002530.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Spinal anesthesia (SA) avoids the need for endotracheal intubation in general anesthesia (GA), reduces the risk of adverse airway events and avoids intraoperative narcotic administration. We hypothesized that SA is a safe alternative to GA in healthy infants with genital anomalies in the ambulatory setting. METHODS: A prospective IRB-approved database for pediatric patients undergoing urologic surgery under SA was created. Typically, patients <10 months and <10 kg are selected for SA. EMLA cream is applied to the L3-L5 interspace for 30 minutes. Patients receive intrathecal plain 0.5% bupivacaine 1 mg/kg without additional sedatives. Clonidine 1 µg/ml is added to extend the duration of the block if the procedure is anticipated to last >75 minutes. Patients are soothed with a sugar solution and pacifier. Patients receive a caudal block following the procedure for postoperative pain relief. Patient age, gestational age, weight, time to place spinal anesthetic, spinal medication(s) used, surgical procedure, procedure length and peri-anesthetic events were recorded. RESULTS: A total of 68 patients were included (Table 1). Mean patient age was 5 months and mean weight was 7.3 kg. Average time for placement of SA was 10.4 ± 2.5 minutes. Clonidine was administered in 42/68 (61.8%), and combined spinal/caudal anesthesia was employed in 8/68 (11.8%). Operative time was >60 minutes in 53 (78%). Of the 68 cases, 1 was converted to GA (1.5%) due to intolerance of laparoscopic insufflation. Adjunctive intravenous sedation was required in 14 cases. Average procedure time was significantly higher among cases performed with combined spinal/caudal catheter (139 vs 73 mins, p <0.001). Intraoperative apnea occurred in 7 patients (5 received clonidine, 2 did not, p=0.285), of whom 4 required manual stimulation while none required further intervention. There were no anesthetic events requiring post-operative management. All patients were brought awake and ready to feed to the PACU and discharged after feeding. CONCLUSIONS: SA is a safe and effective alternative to GA in young infants undergoing outpatient genital surgery. SA reduces the need for invasive airway placement, improves OR efficiency, and shortens PACU time. Surgical time can be prolonged by use of adjuncts such as clonidine and combined spinal/caudal catheter. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e132 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jack Elder More articles by this author Andrew Chen More articles by this author Jacquelin Peck More articles by this author Christine Mai More articles by this author Diana Liu More articles by this author David August More articles by this author Chang A. Liu More articles by this author Expand All Advertisement PDF DownloadLoading ...

Percutaneous Intramyocardial Septal Radiofrequency Ablation in Patients With Drug-Refractory Hypertrophic Obstructive Cardiomyopathy

Patients with hypertrophic obstructive cardiomyopathy (HOCM) and drug-refractory symptoms and outflow gradients have limited nonsurgical treatment options. The feasibility of percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) has been reported previously; however, procedural and medium-term outcomes are unknown. To describe the safety and medium-term outcomes of PIMSRA in a large patient cohort with drug-refractory HOCM. This was a single-arm, open-label study of PIMSRA in patients with drug-refractory HOCM. Patients presenting to the Xijing Hospital in Xi'an, China, between October 2016 to June 2020 with hypertrophic cardiomyopathy. Of 1314 patients presenting with HOCM, 244 fulfilled inclusion criteria of severe resting/provoked outflow gradients of 50 mm Hg or higher, and symptoms of New York Heart Association functional class of II or higher refractory to maximum tolerated medications. After discussion among the heart team, 40 patients underwent surgical or alcohol septal reduction therapy and 4 required treatment of significant coronary artery disease. PIMSRA performed in patients. The primary outcome was 30-day major adverse clinical events: death, emergency surgery, severe effusion requiring intervention, procedure-related stroke, bleeding, and stroke. Secondary outcomes included 30-day technical success and 90-day improvement in outflow obstruction. The mean (SD) age of 200 patients was 46.9 (14.0) years, and 125 (62.5%) were men. Resting or provoked left ventricular outflow tract gradients were 50 mm Hg or higher. The median (IQR) follow-up for all patients was 19 (6-50) months. Thirty-day major adverse clinical events rate was 10.5% (n = 21): there were 2 in-hospital/30-day deaths (1.0%), 7 patients (3.5%) with pericardial effusion requiring mini-thoracotomy, 12 patients (6%) with pericardial effusion requiring pericardiocentesis, and no bleeding or strokes. Other periprocedural complications included permanent right bundle branch block in 5 patients (2.5%), resuscitated ventricular fibrillation in 2 (1.0%), and septal branch aneurysm in 2 (1.0%). There were no permanent pacemaker implantations. At follow-up, maximum septal thickness was reduced from a mean (SD) of 24.0 (5.1) mm to 17.3 (4.4) mm (P < .001), and left ventricular outflow tract gradient was decreased from a mean (SD) of 79.0 (53.0) mm Hg to 14.0 (24.0) mm Hg (P < .001). Overall, 190 patients (96%) with HOCM were in New York Heart Association functional class I or II at last follow-up. This study found that PIMSRA in patients with drug-refractory HOCM may be an effective procedure for relief of left ventricular outflow tract obstruction and symptoms with acceptable complication rates. These results are encouraging and support the design of a randomized clinical trial against well-established septal reduction therapies.

Polysomnography-guided mandibular distraction osteogenesis in Pierre Robin sequence patients.

Craniofacial malformations with micrognathia cause high grades of obstructive sleep apnea (OSA) measured by polysomnography (PSG). Mandibular distraction osteogenesis is a novel procedure for upper airway obstruction relief. Our primary objective was to describe the utilization of PSGs to improve obstruction in patients undergoing mandibular distraction. This is a retrospective study. Patients with micrognathia and severe upper airway obstruction, presenting with severe OSA diagnosed by PSG, were included from a single tertiary care center between 2015 and 2019. PSGs were done (1) prior to surgery, (2) once the cosmetic goal was achieved (Post-Op 1), and (3) if residual moderate-to-severe OSA was seen, every 2 nights until mild or no OSA was achieved (Post-Op 2). Thirteen patients were included. The median age at surgery was 1.1 months (10 days-3 months). All 13 patients had baseline severe OSA, with a median obstructive apnea-hypopnea index of 33 events/h and a median O2 nadir of 73%. Post-Op 1 PSG was done at a median of 6 days after surgery. Median first postoperative obstructive apnea-hypopnea index in all 13 patients was 6.8 events/h, with a median O2 nadir of 87%. A median additional distraction of 3 mm was needed beyond the traditionally recommended advancement. Long-term follow-up studies at or after 1 year were done in 5 patients, all showing persistent nonsevere OSA. This is the first case series utilizing PSGs as a guide for mandibular distraction osteogenesis in patients with micrognathia showing the need for jaw overcorrection to achieve resolution of OSA. Kochhar R, Modi V, de Silva N, etal. Polysomnography-guided mandibular distraction osteogenesis in Pierre Robin sequence patients. J Clin Sleep Med. 2022;18(7):1749-1755.

Impact of the COVID-19 Pandemic on the Management of Dental Pain and Odontogenic Infections in Pediatric Patients

Objective: This study aimed to compare the number of procedures for dental pain relief and odontogenic infection control performed annually in pediatric patients before and during the pandemic to date. Methods: The longitudinal association between the number of procedures to treat pediatric urgent dental emergencies from the previous (2017–2019) to the pandemic (2020) period was evaluated by a negative binomial regression in the form of incidence rate ratio with 95% confidence interval. Results: This study showed a significant decrease in the number of pulp capping, pulpotomy, access to dental pulp and medication, endodontic medication with/without biomechanical root canal preparation, abscess drainage, and extraction of primary or permanent teeth, performed in patients up to 12 years old from the previous to the pandemic period. Conclusions: Therefore, the COVID-19 pandemic has adversely impacted on the number of procedures for dental pain relief and odontogenic infection control performed in pediatric patients.

Unprecedented emergencies during radiofrequency ablation procedure: a case series

Radiofrequency ablation (RFA) of nerves is an upcoming intervention for relieving chronic musculoskeletal pain. However, being relatively new not much publications are available on emergencies during the procedure. 66 years old male, a case of Osteoarthritis knee, underwent RFA genicular nerve of right knee. Conventional RFA of Superolateral, Inferomedial, Superomedial genicular nerves were done under C- arm guidance. Thirty minutes after the procedure, we found a boggy swelling developing over his right knee. It was a hematoma developing on the superomedial aspect of the right kneecap most likely due to injury to Superomedial genicular vessels accompanying the nerve. 67 years old female planned for RFA genicular nerves of both knees under C arm guidance. During the intervention, she complained of numbness around face, and suddenly went into disoriented state with muscle twitching and bluish discoloration of lips. Medicine consultation diagnosed the incident as LA associated systemic toxicity. 57 years old female with chief complaints of pain in left hemiplegic shoulder pain for 6 months duration admitted for suprascapular nerve block. During the procedure patient goes into hypotensive bradycardic episode. 65 years old female admitted for Medial calcaneal block for right heel pain. 24 hours after the procedure she has aggravated pain of foot. RFA is considered as a non-invasive, OPD based procedure for effective pain relief but it is also important to understand such unprecedented emergencies that can happen.

The Placebo-Controlled Effect of Percutaneous Coronary Intervention on Exercise Induced Changes in Anti-Malondialdehyde-LDL Antibody Levels in Stable Coronary Artery Disease: A Substudy of the ORBITA Trial.

Aim: Malondialdehyde-modified low-density lipoprotein (MDA-LDL) forms a significant component of oxidised LDL. The effects of exercise on levels of MDA-LDL and anti-MDA-LDL antibodies are not well-understood. Furthermore, it is not known whether these can be modified in patients with coronary artery disease by percutaneous coronary intervention (PCI).Methods: The Objective Randomised Blinded Investigation with optimal medical Therapy of Angioplasty in stable angina (ORBITA) trial was the first blinded, multi-centre randomised trial of PCI vs. placebo procedure for angina relief. Serum samples were available at four time-points: pre-randomisation pre- (P1) and post- (P2) exercise and post-randomisation (6-weeks following the PCI or placebo procedure), pre- (P3) and post- (P4) exercise. ELISAs were performed using laboratory-developed assays for MDA-LDL (adjusted for Apolipoprotein B) and anti-MDA-LDL antibodies.Results: One hundred ninety-six of the 200 patients (age 66.1 [SD 8.99] years, 28% female) with severe single vessel coronary artery disease suitable for PCI enrolled in the ORBITA trial had blood available for analysis. With exercise at pre-randomisation (P2–P1) there was no significant change in adjusted MDA-LDL (−0.001, 95% CI −0.004 to 0.001; p = 0.287); however, IgG and IgM anti-MDA-LDL significantly declined (−0.022, 95% CI −0.029 to −0.014, p < 0.0001; −0.016, 95% CI −0.024 to −0.008, p = 0.0002, respectively). PCI did not have a significant impact on either the pre-exercise values (P3 controlling for P1) of MDA-LDL (p = 0.102), IgG (p = 0.444) or IgM anti-MDA-LDL (p = 0.909). Nor did PCI impact the exercise induced changes in these markers (P4 controlling for P1, P2, and P3) for MDA-LDL (p = 0.605), IgG (p = 0.725) or IgM anti-MDA-LDL (p = 0.171). Pre-randomisation ischaemia on stress echo did not impact these interactions.Conclusions: Exercise results in an acute reduction in anti-oxLDL antibodies in patients with severe single vessel coronary disease, possibly indicating an induction in homoeostatic clearance via the innate immune system. However, PCI did not ameliorate this effect.

Percutaneous osteoplasty for painful bony lesions: a technical survey.

Percutaneous osteoplasty (POP) is defined as the injection of bone cement into various painful bony lesions, refractory to conventional therapy, as an extended technique of percutaneous vertebroplasty (PVP). POP can be applied to benign osteochondral lesions and malignant metastatic lesions throughout the whole skeleton, whereas PVP is restricted to the vertebral body. Common spinal metastases occur in the thoracic (70%), lumbosacral (20%), and cervical (10%) vertebrae, in order of frequency. Extraspinal metastases into the ribs, scapulae, sternum, and humeral head commonly originate from lung and breast cancers; extraspinal metastases into the pelvis and femoral head come from prostate, urinary bladder, colon, and uterine cervical cancers. Pain is aggravated in the dependent (or weight bearing) position, or during movement (or respiration). The tenderness and imaging diagnosis should match. The supposed mechanism of pain relief in POP is the augmentation of damaged bones, thermal and chemical ablation of the nociceptive nerves, and local inhibition of tumor invasion. Adjacent (facet) joint injections may be needed prior to POP (PVP). The length and thickness of the applied needle should be chosen according to the targeted bone. Bone cement is also selected by its osteoconduction, osteoinduction, and osteogenesis. Needle route should be chosen as a shortcut to reach the target bony lesions, without damage to the nerves and vessels. POP is a promising minimally invasive procedure for immediate pain relief. This review provides a technical survey for POPs in painful bony lesions.